What is Purging in Eating Disorder?

“I'm 21 years old now, and I've struggled with my weight and self-esteem since junior high. As a typical, awkward preteen, I was chubby, wore braces, and had acne. I was self-conscious about everything, especially my weight.

As I entered high school, my concern about my body grew stronger. Then one day, I looked at myself in the mirror, still not entirely sure what I was doing. Then I pulled my hair back into a ponytail, knelt over the toilet, and made myself sick.

I wish, with all my heart, that I had not done so. It may seem like a great way to control your weight, but instead it wreaks havoc on your body. That you may think you’ll only do it occasionally, but like any addiction, it will become your life. I wish I could tell them to say NO to that first, not-so-powerful urge.”

“My on again, off again relationship with bulimia throughout high school and university was not something I considered serious – at the time. It was my coping mechanism, something I could fall back on when I was feeling fat, stressed or upset. I would go for weeks without making myself sick, the pattern was incredibly sporadic. I was in complete control of my bulimia. When I was 22 – bulimia gained control over me. I had just graduated from university. Society was expecting me to ‘go out and get a job’. Along with a job, I was supposed to get an income, a place to live, and to support myself completely independently for the first time in my life. I was terrified. At that very moment, I was feeling rejected and worthless. A serious boyfriend had dumped me, for the second time in my life. It was not a great phase for me. I didn’t eat, I didn’t sleep, and I spent my time either crying or listening to the reasons why I shouldn’t exist. As a result, I began to lose weight. I didn’t even realize at first that I was getting smaller. My friends and family did.

Two important things happened one weekend.

One was that my mother stumbled across my ‘secret’. The second was that I met someone. That someone turned out to be my rock. He has been so supportive and affirmative throughout my entire journey.

I began a roller coaster of a journey. I explored several therapists and support groups before finding a good fit. I worked with an amazing dietician who helped me to rediscover the importance of food. I had intense sessions with a counsellor who assisted me in confronting my issues. I went up, I went down. I had days when I felt on top of the world. I felt in control, healthy, and happy. I also had days where I hit rock bottom.”

"I am 11-year-old. I would scream at myself in the mirror not to succumb to the urge and end up in a puddle of tears on the bathroom floor. I desperately wanted not to do it. I knew my cheeks were sunken, my blood vessels could be seen, my food canal was irritated, and my body was suffering. Finally, I let my parents discover it. They were devastated but understanding.  I wasn't allowed to leave their company after food. They took me to a therapist. I clicked with her immediately, and she helped me understand what was going on. I started to feel better about myself, and my relationship with my parents improved. I stopped purging and found new ways of dealing with my stress.”  

Types of Purging

Purging involves eliminating food and calories from the body.

It is commonly observed in individuals with bulimia nervosa or similar eating disorders. Purging can occur at any time, but is often following a binge eating episode.

Purging behaviors are often misunderstood as merely food vomiting, but they also encompass excessive laxative and diuretic use, insulin misuse, and overexercising. Here's a breakdown of common types:

Self-induced vomiting: The most recognized form, where a person deliberately expels consumed food.

Laxative/diuretic abuse: Using laxatives to cause diarrhea or diuretics to promote water loss, often for weight control.

Insulin misuse/mismanagement: Some with type 1 diabetes manipulate insulin to purge. Adolescent females with type 1 diabetes are twice as likely to have an eating disorder as their non-diabetic peers.

Excessive exercise: Overexercise is sometimes used to compensate for calorie intake.

Understanding Purging

Why Do People Purge?

There are many reasons that people with eating disorders may purge.

• Compensatory purging: Sometimes, after a binge eating episode, people might purge to try and make up for what they've eaten. Many describe feeling guilty, ashamed, or worried about gaining weight after eating something they see as 'bad,' breaking a food rule, or losing control over their eating. During these moments, purging can feel like a way to take back some control and balance out the energy they consumed.

• Attempts to control weight and shape can be quite intense, sometimes involving purging after each meal and snack, no matter what or how much was eaten, and whether or not there was a feeling of losing control. This is often referred to as ’non-compensatory’ purging.

• Managing feelings: Some individuals with eating disorders find that purging can temporarily ease negative emotions like anxiety, distress, shame, or guilt—both in daily life and following binge-eating episodes.

• Managing physical sensations: Other people struggle to sit with the sensation of normal fullness after eating and use purging to try to ‘get rid of’ this feeling or to make their stomach feel ‘empty’. The physical symptoms of anxiety can also be mistaken for feelings of fullness (think about where you feel anxiety in your body.

Risks with Purging

·       All types of purging can lead to dehydration, which then causes an imbalance in electrolytes like potassium—crucial for keeping our hearts healthy. This imbalance might make you feel dizzy or faint, and in the worst cases, it can pose a serious risk to your heart, even leading to heart failure. Remember, taking care of your health is so important.

·       When you vomit, stomach acid can reach your mouth and wear down your tooth enamel, which makes your teeth more vulnerable to damage. Since tooth decay can't be reversed, it's important to take steps to prevent further harm to your teeth.

·       Purging can upset your normal bowel routine, so you might notice more constipation or diarrhea, along with bloating and gas. If you use laxatives, it's common to find that over time, you need a higher dose to see the same results. Many laxatives, especially those containing Senna, could potentially cause lasting damage to your bowel, so it's best to stop using them. Taking care of your digestive health is really important, and consulting with a healthcare professional can help you find safer options.

If you or anyone you know is purging, please help them seek help. A few sessions with your primary healthcare professional, dietitian, or mental health professional may help you before the eating disorder gets out of control again.